Given rapidly changing practices in the IVF arena, it is becoming increasingly implausible to reliably interpret current national reports expressing IVF outcome statistics as birth rate per initiated treatment cycle, per egg retrieval procedure or per embryo transfer procedure performed. ….AND here is why:
- There has with good justification been a strong move to perform embryo transfers on day 5-6 (blastocyst-ET) rather than on day 3. Such practice have inevitably resulted in more and more women (especially older women and those who have diminished ovarian reserve) failing to reach embryo transfer.
- The growing trend of freezing and “stockpiling (banking) embryos” for future use, coupled with the expansion of full embryo karyotyping (e.g. CGH), in many/most cases requires delaying ET to a later cycle (Staggered IVF) in order to have test results available for embryo selection.
- There is presently a wide center-to-center variation in the number of embryos being transferred at a time. This is sometimes due to patient insistence but all too often is done in an attempt to bolster IVF success rates. The result is an unacceptably high multiple birth rate.
- Currently, oversight is lacking when it comes to insuring the accuracy of IVF success rates reported by different clinics, thereby creating an uneven playing field and skepticism about reported results.
The time has come to move to a simpler, more reliable, less costly and verifiable method, one that at a glance would on the spot, compare standards of IVF services on a “level playing field”. This could be readily achieved by focusing primarily on the viablepregnancy rate (those that have advanced beyond the 12th week of pregnancy) per transferred embryo. The data would be further subclassified on the basis of the woman’s age and by the type of procedure performed (e.g., age, fresh cycles, frozen embryo transfers (FET), egg donation, etc.).
Expressing IVF success/competence in terms of outcome per embryo transferred, would not only lead to a drop in the number of embryos transferred per procedure and accordingly a likely decline in the high national multiple birth rate but would also facilitate oversight of reported results and provide consumers with an ability to readily evaluate and compare proficiency on a level playing field.
The College of American Pathologists (CAP) is already charged with overseeing all IVF laboratories and in the process of so doing, tracks the fate and disposition of all gametes and embryos propagated. Using their data, it would, it would be a simple and inexpensive exercise to individually and collectively link the origin, disposition and destination of all eggs/embryos and in the process validate reported rates.
Since the difference between the ongoing IVF pregnancy rate beyond the 1st trimester and birth rate is insignificant, we at SIRM will test this new approach which focuses on the ongoing pregnancy rate per embryo transferred (PRPE). As such, in addition to reporting in the required format to SART/CDC we will also be posting PRPE data on our website, www.haveababy.com. We will begin posting on a quarterly basis and thereupon as the data base grows….. Semiannually.
We understand that recent changes in the outcome parameters embodied in SART/CDC annual reports (e.g. adding into the statistics, the outcomes of all IVF cycles that were initiated) were made to provide a full accounting of the amount of work that goes into propagating each IVF pregnancy. Although such intent is laudable, the simple truth of the matter is that such data presentation, while clarifying one aspect of the picture will often obscure another. In reality, many IVF cycles are currently not seen through to the point of embryo transfer for reasons that have nothing to do with an IVF facility’s expertise. Rather such reasons often reflect last minute personal choices made by the patient to enhance the prospects for a favorable long-term outcome of treatment.